Petersen Health Properties, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0047431 Issued in IL

Legal business name

PETERSEN HEALTH PROPERTIES, LLC

Doing business as

Coutryview Care Center of Macomb

Practice address

400 W Grant St
Macomb, IL 61455-2867

Phone

(309) 837-2386

Fax

(309) 836-9191

NPI assigned

Jun 4, 2006

Last updated

Dec 31, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark B. Petersen

Title

Manager

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Coutryview Care Center of Macomb Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Petersen Health Operations, LLC

  dba Cisne Rehabilitation & Health Center

  • Nursing Facility/Intermediate Care Facility
  • Cisne, IL
  • NPI 1225071442

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1730127218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 W TRAILCREEK DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141862",
            "telephone_number": "309-691-8113",
            "fax_number": "309-691-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W GRANT ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614552867",
            "telephone_number": "309-837-2386",
            "fax_number": "309-836-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH PROPERTIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0047431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20-3224201015",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coutryview Care Center of Macomb",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coutryview Care Center of Macomb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dana Peacock
• Pediatric Therapy Services of Macomb, LLC
• Rachel Ellen Pelton
• Michael Patrick Pendergast Sr., ATC
• Petersen Health Operations, LLC (Countryview Care Center of Macomb)
• Jennifer M Plos, ATC
• Kathryn Ann Pohlpeter
• Renee L Polubinsky, ATC, CSCS
• Orie R Potter, PAC MPAS
• Melissa L Pounders, NP-C

• Skilled Nursing Facility in Macomb, IL
• Providers in Macomb, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.